Tuesday, July 14, 2009

There is a principle in science called parsimony. It refers to the idea that the simplest explanation for an observed event is most likely the best explanation.

An example would be when I tuck in my children to sleep and ask if they had brushed their teeth. If they say “Yes” and then I go in the bathroom and notice that the toothbrushes are dry, I can consider several possibilities:

They didn’t brush their teeth at all.

They brushed their teeth but then took the time to meticulously dry their toothbrushes.

They brushed their teeth but my wife then came and dried the toothbrushes.

The children were bought a new type of “quick-dry” toothbrush.

Aliens intruded our home and dried out the toothbrushes.

The rule of parsimony suggests that the simplest explanation—that they didn’t brush their teeth at all—is the likeliest explanation.

This same principle can be applied to the question, “Why do some children misbehave?” There are several possible explanations for this phenomenon:

The child has a biochemical imbalance in the frontal lobes, which makes him unable to make good decisions, except of course when the child is watching TV, playing video games, or building with Legos.

The child is possessed by the spirit of Sponge Bob Square Pants, which mysteriously releases its grip from the child when the child is watching TV, playing video games, or building with Legos.

The child possesses the ability to behave, but has not yet learned how to inhibit his impulses or obey his parents, and will when his parentsproperly motivate him to do so.

Explanation #3 is more than sufficient for the vast majority of children with behavioral and academic problems. We don’t need any other explanations.

Sometimes a medical explanation—even a scientific explanation—is unnecessary, because common sense offers a sufficient explanation. The same can be said for the most common mood disorders (Depression and Bipolar Disorder) and anxiety. There are plenty of sound, sensible explanations for these struggles that do not require a medical diagnosis.

Let’s stop looking for brain dysfunction in our children and start seeing the functionality of their behaviors and emotions.

My primary argument is that option 3 is quite sufficient; the vast majority of children are quite ABLE to behave properly and will, given the proper motivation, boundaries, etc.

As for what I'm advocating, I am certainly against overdiagnosis. But that isn't quite it. I am highly critical of the entire field of psychiatry for two reasons.

First, because of their philosophical underpinnings and the presuppositions they bring to the table. Fundamentally, psychiatrists presuppose that there is a medical explanation for the behavior problems that are diagnosed in ADHD. I believe this is a fatal flaw.

Second, psychiatry has but one tool to effect change in their patients: drugs. Sure, they also use lobotomy ("psychosurgery") and ECT, but the profession is essentially like a carpenter who has nothing but a sledgehammer.

As a parent who is desperately seeking the correct ways (methods, motivations, boundaries, whatever you want to call it) to help an ASD child learn to behave, I am quite interested in what you have to say. We have found a few things that really work with our daughter maybe 95% of the time, and then 5% of the time it seems like nothing works. The things that do work require an enormous amount of energy, attention, time and effort to keep in place. I guess my point is, even if there are ways to help all children learn to behave well, does that discount that there are underlying psycho/bio/neurological conditions that make it harder for those children to learn to behave well, and while it may be all well and good to put in the extra effort that it takes to help a child learn to behave well drug-free (certainly our goal), does it not behoove us as a society to work in a multi-disciplinary fashion to understand every aspect of what is going on with these children in order to help all of us function better as a society? I agree that the whole diagnosis process is pretty messed up (no one can quite agree, for instance, exactly where on the spectrum our daughter is) but at least in the case of ASD, and I think at least some ADHD cases as well, the degree of difficulty that these kids have in learning to fit into their world can hardly all be chalked up to errant parenting.

Thank you for your comments; I appreciate your candor and your dilemma.

When I referred to the "vast majority" of children with behavioral problems, I did not specify the small minority of children whose behaviors I believe are NOT due to imperfect parenting. I'm not going to make a full argument here re: why I believe this, but I do believe that autism IS fundamentally different than ADHD in that it is truly a neurological or biologically-based disorder. I approach children with ASD very differently as a result.

That being said, I am sure you are aware of Applied Behavior Analysis, which stems from the work of Lovas (I may be spelling his name wrong; forgive me). It involves, as you said, herculean work, but it can bear tremendous fruit when done properly and consistently, even with severely autistic children.

My argument is primarily focused on baloney diagnoses like ADHD and Oppositional-Defiant Disorder, not the Autistic Spectrum Disorders. I hope that clarifies things for you and other readers.

I would also add that of course clinicians and parents should always seek to fully understand the root causes of behavioral/emotional/academic/relational problems. Using a paradigm that is too narrow or simple can be just as harmful (e.g., presuming a child with Tourette's is simply misbehaving and that poor discipline is the root cause). Again, ADHD and ODD are fundamentally different.